Oh my goodness, another over 40 year old female comes into my clinic and starts to cry with relief when she understands that her condition is common.  When she tells me about her horror visit to her local GP doctor–and I guessed, conspiratorially winking and with a smile- that he wanted to put her on antidepressants because, well she is TIRED, always feeling cold, lethargic, gaining weight and doesn’t want to do anything — I shook her hand and welcomed her to the “HypoT club”!

You see it’s an epidemic.  My husband and I have been struggling with signs and symptoms of hypothyroidism for several years, but generally it goes undiagnosed in MOST people (and their pets!)

To be fair to the overworked and stressed doctor (remember my husband is one of those! He was in denial about his hypoT for YEARS) It is tricky to diagnose, and unless the root cause and underlying factors are addressed, hormone replacement therapy is going to be palliative and lifelong.

So what’s the buzz? Why is this problem out of control?

 Hypothyroidism is a condition where the thyroid, a bilobal butterfly shaped hormonal gland situated at the base and front of the neck anterior to the trachea, is underactive. The product of this gland is thyroxine, which affects many organ systems and their metabolic actions in the body, including growth factors, skin condition, body and head hair growth, heart rate, core body temperature and how rapidly food calories are burned. The onset can be slow and insidious with multiple other dis-sease taking place concommititently. Hypo functioning of this gland  therefore can present as a wide range of symptoms and pathology.

Causes:  1) Deficiencies: Nutrient deficiency of Iodine, Selenium, and the amino acid Tyrosine as well as other minerals and nutrient factors contribute to the inability of the thyroid gland to manufacture Thyroxine are common causes, as well as antinutrient binding factors from ingesting Brassica plants. Areas that have low Iodine in the soil are referred to as “geographic goitre belts” as Iodine deficiency causes the thyroid to enlarge developing a goitre. (Hechtman,L 2012) A diet deficient in essential minerals, amino acids, and good fat with exposure or ingestion of fluoride, pesticides, aromatase inhibitors- such as weedicides like round up residues (eg. On fruit and vegetables ingested, or in drinking water or skin exposure) exposure to radiation and drugs have all been implicated as causative factors. (AIAS Nut 4 notes) Autoimmune or Hashimoto’s Thyroiditis is the most common cause of hypothyroidism especially in women over the age of 45 years. Its pathogenesis and increased frequency in women of this age group is unknown, but at this age a drop in progesterone which maybe protective and anti-inflammatory agent -plus an increase in inflammatory cytokines, with adipose tissue releasing oestrogens it is possible that the T helper H1;H2 cell ratio may favour the inflammatory autoimmune axis.

2) Excesses:  Many articles attribute a cause and effect principle from vaccines, insecticides, PCB’s (polychlorinated biphenols), plastics, Chlorine and fluorine and other toxins in the environment. (Mercola.com).  Dr Bill Osmunson, (Mercola interview) a dentist and health researcher, has studied this extensively and recommends that fluoride levels should be monitored and reduced to less than 1 ppb, and that the public water supply should not be fluoridated for these health reasons. Animal studies have documented hypothyroidism as an effect of fluorosis- which has been well known in the Veterinary field for many years where Thyroxine and triiodothyronine levels in serum decreased with increasing urinary fluoride (Hillman D, 1979).

Signs and Symptoms: Patients with hypothyroidism may be overweight and find it difficult to lose weight, may feel sluggish and lethargic, have dry itchy skin, experience brain fog, exhibit oedema and puffy features. They may also have shortness of breath, constipation, flatulence and bloating, and recurrent infections. Other features of this disease include infertility and low libido, fibrocystic breast disease, myalgia, athralgia, cold intolerance, decreased sweating and headaches. Some classic clues that may alert a naturopath include facial diagnosis of hypothyroidism such as yellow bumps/lumps (cholesterol deposition) on the eyelids and loss of hair on the lateral parts of the eyebrows. These may occur prior to any serological changes on TSH (Thyroid stimulating hormone) which will become elevated eventually when the pituitary gland recognises that there is an underproduction of T3 and T4. Hypercholesterolaemia and lipidemia, causing atherosclerotic plaques, hypertension, and coronary artery disease are also a feature of uncorrected hypothyroidism.  Another diagnostic tool is to take a morning heart rate and temperature, if the heart rate is below 60 in an unfit individual and if the body temperature is 0.5-1degree lower standard this may indicate a clinical sign.  Myxoedema Coma is a life threatening condition that can occur if Hypothyroidism is left untreated and a major incident such as hypothermia occurs. (AIAS notes, 2013)

Current Research: There is a widespread and apparently recent increased incidence of hypothyroidism with an insurgence of Hashimoto’s Thyroiditis. This is best measured by serological testing for Thyroglobulin Auto Antibodies (TgAA).  In this disease the body produces antibodies to its own thyroid, eventually causing its destruction and inability to produce thyroxine. This can occur in conjunction with other autoimmune dysfunctions such as pernicious anaemia, rheumatoid arthritis, lupus, and yeast infections.  Excessive vaccinations with protein tissue culture that may contain analogous thyroid proteins may also trigger autoimmune Thyroiditis. This work has been documented in many breeds of domestic dogs, a species that have similar metabolism to humans; which brings into question the effect of “regular” vaccines. (Dodds,J 2011) The literature is spurious and there is very much debate regarding human vaccinosis and a causative link, however(Wakefield, 2012).

If the TSH continues to rise more antibody appears to be produced, a so-called paradox. Therefore treatment is based on supplementation with low dose thyroxine to prevent TSH elevation and further stimulation of the Thyroid gland. The consequences of uncorrected hypothyroidism include Cholesterolaemia, Coronary Heart Disease, and death- usually by atherosclerotic plaque formation and often blockage of the Left anterior descending coronary artery. (Donnay, et al 2013) Recently  an increased incidence in congenital hypothyroidism has been reported, as noted in the Journal of paediatrics (Parks JS, 2013) with the four major aetiologies  listed as maternal thyrotropin receptor-blocking antibodies, exposure to maternal antithyroid medications, iodine deficiency, and iodine excess.

Dietary recommendations: It is particularly important to prevent hypothyroidism in children. Children with hypothyroidism can develop Cretinism, deafness and dwarfism, (Melse-Boonstra A, 20013) therefore it is essential that mothers and pregnant women are especially aware of the correlation between goitrogenic diets and low intakes of Iodine, Selenium and Tyrosine. This means that cabbage, brussel sprouts, broccoli, broccolini, and cauliflower should be eaten in moderation with kelp, seafood, Brazil nuts and/or an Iodine and Selenium supplement. Eating oily fish three times a week- such as Salmon, Mackerel and Nori and Miso soups will help avoid Iodine deficiency. Having a healthy gut without small intestinal bowel overgrowth, dysregulation or leaky gut will enhance nutrient absorption and prevent some of the trace mineral and nutrient deficiencies that cause stress and dysfunction to the body, which could contribute to hypothyroidism.

Supplement recommendations:  A Natural source of Iodine is preferable to add to the diet such as Kelp 2-3 gm/day, bladderwrack or other sea vegetables and fish. This is because trace cofactors are present in food sources and allow easier assimilation of the Iodine.  However due to Fukushima’s radioactivity and oceanic flow (towards California, Hawaii, USA- NOAA debris map- see ref #17) it is best to source these from deep southern waters or far north eg. Alaskan or Norwegian Salmon. Alternatively Potassium Iodide as a supplement has been shown to protect the thyroid from absorbing radioactive Iodine from these fallout sources. (Reiners, C 2013) with other co-factors 500 mg L tyrosine twice daily, vitamin B’s all at 100 mg 3x/ daily plus extra vitamin (these can be taken as Torula or Brewer’s yeast 1 teaspoon tds) and B12 1000-200mcg/day sublingually, vitamin C with bioflavonoids 500 mg 4 times daily for immune function and stress. It is cautioned to not take extreme doses as diarrhoea and loss of trace minerals could occur. Vitamin A 10,000 IU daily, Vitamin E 200 IU daily or 400 IU every other day in the D-alphatocopherol form. Zinc 50 mg daily as immune stimulant/balancer. Selenium 20-40 mcg/day to balance vitamin E.(AIAS Nutrition notes 2013)

If supplementing with Iodine, a Polish study  (Debska, 2010) found the dose recommended to be a minimum 150 μg of iodine/day.  Too much Iodine over a prolonged period of time has been shown to lead to hyperthyroidism as shown in the rat model (Hussein Ael-A 2012) the Feline (Hill’s research, pers com 2013) and human patients (Dr Byan pers com).

Dessicated Thyroid extract appear to be favoured over synthetic thyroxine by many patients. (Hoang TD et al 2013) This may be due to the various synergistic biological and biochemical compounds that are present in the bovine, porcine or ovine thyroid products that are taken orally.

Various herbs have been suggested to be of benefit to the thyroid gland, such as Bayberry, goldenseal, Swedish bitters, Gentian, Mugwort, Black Cohosh. (AIAS  Nutrition notes), Rhodiola rosea (Zubeldia, 2013) and other fruit peel; which possibly might be due to the polyphenols and vitamin C -anti-atherogenic effect of these substances (Parmar HS, 2013)

Hence in treating Hypothyroidism attention must be made to the overall diet with regards to reducing goitrogens, improving digestion and increasing Sea vegetables and trace minerals (Iodine, Selenium, tyrosine, B vitamins), lifestyle (stress reduction, and regular exercise), avoidance of toxins (too many vaccinations, fluoride, PCB’s and others) detoxifying, and increasing antioxidants.

References

1.      AIAS student notes Nutrition, Massage, Nat  2007-2013

2.      Bone,K. (2007).The Ultimate Herbal Compendium.Warwick, Qld:Phytotherapy Press

3.      Hechtman,L (2012). Clinical Naturopathic Medicine.Elsevier,Australia

4.      Hybertson BM, Gao B, Bose SK, McCord JM. Oxidative stress in health and disease: the therapeutic potential of Nrf2 activation.Mol Aspects Med. 2011 Aug;32(4-6):234-46. doi: 10.1016/j.mam.2011.10.006. Epub 2011 Oct 15

5.      Mills,S, BoneK Principles and Practice of Phytotherapy: Modern Herbal Medicine 1999, Elsevier

6.      Osiecki, H. (2010) The Nutrient Bible 8th Edition, Orthoplex.Australia

7. Nutr Res Rev. 2013 Jun 12:1-8. [Epub ahead of print]Iodine deficiency, thyroid function and hearing deficit: a review. Melse-Boonstra A, Mackenzie I.Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
8. Rev Clin Esp. 2013 Jun 15. pii: S0014-2565(13)00164-1. doi: 10.1016/j.rce.2013.04.009. [Epub ahead of print]Burden of illness attributable to subclinical hypothyroidism in the Spanish population.[Article in English, Spanish]Donnay S, Balsa JA, Alvarez J, Crespo C, Pérez-Alcántara F, Polanco Cervicio de Endocrinología y Nutrición, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.

9.      Whitney,E, Rolfes SR, Crowe, T, et al (2011) Understanding Nutrition Cengage Learning, Australia

10.  Pediatrics. 2010 May;125 Suppl 2:S54-63. doi: 10.1542/peds.2009-1975F.The impact of transient hypothyroidism on the increasing rate of congenital hypothyroidism in the United States.Parks JS, Lin M, Grosse SD, Hinton CF,Drummond-Borg M, Borgfeld L, Sullivan KM.Division of Pediatric Endocrinology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA. jparks@emory.edu

11.  J Clin Endocrinol Metab. 2013 May;98(5):1982-90. doi: 10.1210/jc.2012-4107. Epub 2013 Mar 28.Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study.Hoang TD, Olsen CH, Mai VQ, Clyde PW, Shakir MK.Department of Endocrinology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, Maryland 20889-5600, USA.

12.  Clin Endocrinol (Oxf). 2013 Feb;78(2):155-64. doi: 10.1111/cen.12066.Selenium and the thyroid gland: more good news for clinicians.Drutel A, Archambeaud F, Caron P.Department of Endocrinology and Metabolic diseases, Hôpital du Cluzeau, Limoges Cedex, France.

13. Can J Physiol Pharmacol. 2012 May;90(5):617-25. doi: 10.1139/y2012-046. Epub 2012 May 2.Effect of chronic excess iodine intake on thyroid function and oxidative stress in hypothyroid rats.Hussein Ael-A, Abbas AM, El Wakil GA, Elsamanoudy AZ, El Aziz AA.Department of Medical Physiology, Faculty of Medicine, Mansoura University, Egypt. zizomenna@yahoo.com
14. Hills Pet food Nutritionists, Veterinary Specialists http://www.hillspet.com.au/ pers com AVA conference Cairns, Australia 2013
15. Radiat Environ Biophys. 2013 May;52(2):189-93. doi: 10.1007/s00411-013-0462-0. Epub 2013 Mar 9.Potassium iodide (KI) to block the thyroid from exposure to I-131: current questions and answers to be discussed .Reiners C, Schneider R.Department of Nuclear Medicine, German WHO-REMPAN Collaboration Center, Hospital of the University of Wuerzburg, Wuerzburg, Germany. reiners_c@klinik.uni-wuerzburg.de
16. Dr Bryan Cebuliak MD practicing physician for 40 years in general practice, presently Morayfield Medical Centre
17. http://oceanservice.noaa.gov/news/features/dec11/japan-tsunami-debris.html
18. J Med Food. 2010 Dec;13(6):1287-92. doi: 10.1089/jmf.2009.0286. Epub 2010 Oct 14.Exploring new applications for Rhodiola rosea: can we improve the quality of life of patients with short-term hypothyroidism induced by hormone withdrawal?Zubeldia JM, Nabi HA, Jiménez del Río M, Genovese J.Department of Applications, Safety and Regulations, Polinat S.L., Taibique, Polígono Industrial Las Majoreras, 35240 Ingenio, Las Palmas, Spain.jose@polinat.com
19. Biofactors. 2008;33(1):13-24.Possible amelioration of atherogenic diet induced dyslipidemia, hypothyroidism and hyperglycemia by the peel extracts of Mangifera indica, Cucumis melo and Citrullus vulgaris fruits in rats.Parmar HS, Kar A.Endocrine Research Unit, Devi Ahilya University, Indore, MP, India. hamendrasingh999@yahoo.co.in
20. Dodds, J W, Laverdure, D R. (2011) The Canine Thyroid Epidemic  Dogwise publishing, Washington, USA
21. http://articles.mercola.com/sites/articles/archive/2011/10/11/dr-bill-osmunson-on-fluoride.aspx
22. Endokrynol Pol. 2010 Nov-Dec;61(6):646-51.Iodine status of pregnant women from central Poland ten years after introduction of iodine prophylaxis programme.Gietka-Czernel M, Dębska M, Kretowicz P, Jastrzębska H,Kondracka A, Snochowska H, Ołtarzewski M.Endocrinology Department of Medical Centre of Postgraduate Education, Warszawa, Poland. malgietka@vp.pl
23. J Dairy Sci. 1979 Mar;62(3):416-23.Hypothyroidism and anemia related to fluoride in dairy cattle.Hillman D, Bolenbaugh DL, Convey EM.

24.  Treatment and Management of SIBO — Taking a Dietary Approach Can Control Intestinal Fermentation and InflammationBy Aglaée Jacob, MS, RD
Today’s DietitianVol. 14 No. 12 P. 16 Dec 2012